Corticosteroids and Male Infertility

 Written by Ben Bunting: BA(Hons), PGCert.

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The link between corticosteroids, such as prednisone, and male infertility has been discussed in the medical community for many years.

This article guides you through the process of deciding whether corticosteroids will be damaging for male infertility, and addressing the various challenges associated with their use.

In this article we shall cover the following points:

• What are corticosteroids?
• Common uses
• Corticosteroids vs anabolic steroids
• Common risks
• Associated risks
• Types
• What's male infertility?
• Do corticosteroids affect male fertility?
• Conclusion

What are Corticosteroids?

Corticosteroids have been used to treat a variety of conditions for over seven decades, dating back to their introduction to rheumatoid arthritis in 1949.

The potent symptomatic relief they provide many patients is one of the major drivers of corticosteroid use.

These powerful medications that are administered via injection, topical creams, or inhalation.

They are effective hormone medications that are used to reduce inflammation and support healing in the body.

They are also used to suppress immune cells to reduce the visibility of autoimmune diseases.

Corticosteroids are a class of drugs commonly prescribed by a medical professional, although this isn't always the case and some over the counter products are available depending on their use.

Common Uses of Corticosteroids

Creams/gels

One of the most common forms of administration for corticosteroids is via topical application.

These can be used by healthcare practitioners and patients to hide various types of blemishes, bruises, and other skin conditions.

Most over-the-counter medications, including acne medication and many cosmetics, contain topical doses of corticosteroids to treat visible signs of acne and cosmetic reactions.

Other uses are include reducing the irritation experienced with piles or haemorrhoids.

Injections

Corticosteroid injections are available to relieve arthritis pain in an inflamed joint when it flares.

Addison's disease occurs when your body does not make enough cortisol, which causes weakness and fatigue among other symptoms. Corticosteroids can compensate for this difference.

If you have recently received an organ transplant, corticosteroids help suppress your immune system, reducing the chance of rejection.

Asthma and hives are treated using localized steroids. Lupus and multiple sclerosis can be treated with systemic steroids.

It has been found that the administration of corticosteroids reduces mortality among COVID-19 patients who need oxygen.

Oral

In the outpatient setting, oral corticosteroids are often used to treat conditions with clearly defined pathophysiology.

This can include such conditions as asthma, chronic obstructive lung disease, rheumatoid arthritis, and inflammatory bowel disease.

Corticosteroids are available in pill form, inhaled powders, or liquid form.

This medicine may be used to treat asthma attacks that do not respond to other asthma medications.

Oral corticosteroids are often prescribed for acute asthma flare-ups to reduce inflammation and swelling in the airways.

One study found that OCS reduces emergency room visits and hospitalizations related to asthma.

A 2018 Asthma and Allergy Foundation of America (AAFA) survey of 519 patients with asthma found that nearly 85 percent used at least one course of OCS in the previous 12 months and 64 percent had done so two or more times.

Are Corticosteroids the same as Anabolic Steroids?

While both are called "steroids," they're not alike. Corticosteroids are different to anabolic steroids.

Anabolic steroids are derived from the growth hormone testosterone and often manufactured in a laboratory to mimic the effects of naturally secreted hormones.

They can be used in hormone replacement therapy, or to treat growth disorders and other diseases.

Anabolic steroids, however, have been often used by athletes and the public to increase muscle protein synthesis.

In this way, they are considered performance-enhancing drugs as they can help improve recovery which means you can train for longer, and harder.

This results in strength and muscle mass gains.

Anabolic steroids are banned

All athletic competitions have banned anabolic steroids.

The use of anabolic steroids without a prescription is illegal in the United States, however, this is not always the case in other countries or regions of the world.

Differences

Corticosteroids and Anabolic Steroids bind to different receptors to create different effects.

Corticosteroids bind to the glucocorticoid receptors whereas anabolic steroids bind to androgen receptors.

Anabolic Steroids are typically used by athletes to maximize muscle mass, whereas Corticosteroids are commonly prescribed to treat inflammatory conditions and arthritis.

They are not the same, but medical professionals may use the two treatments together for a long list of purposes.

Corticosteroids are very effective at managing skin conditions such as eczema and psoriasis, but they can impair bone and muscle growth. by increasing oxidative stress.

To improve the results, topical steroids are often combined with vitamin D.

Common Risk of Corticosteroids

As we know, corticosteroids are synthetic hormones that are used to reduce inflammation.

They are often prescribed to people who have rheumatoid arthritis, lupus, or other autoimmune diseases.

In recent years, it has been widely used to treat various inflammatory diseases, such as diabetes.

There are not all patients who will develop side effects. Each person's frequency of having any side effects differs.

➡️READ: Natural treatments for male infertility

However, long term use of corticosteroids is generally avoided due to serious acute complications such as infection, thromboembolism, avascular necrosis, and fracture, as well as chronic diseases such as diabetes.

As a result, corticosteroids are one of the most common reasons for hospitalization for drug related adverse events and optimizing their long-term use has been a major focus for clinical guidelines across diverse specialties for a long period of time.

However, the risk of complications associated with short-term use is much less understood, and the evidence is generally inadequate to guide physicians.

Short term use

Corticosteroids are also often used for the short term to treat other common conditions where evidence is lacking, such as non-specific musculoskeletal pain and rashes.

Even with such widespread indications for oral corticosteroids, little is known about how these drugs that are prescribed for short-term use in the general adult population, or their potential harm.

If steroid use lasts for a brief period (from a few days to a couple weeks), it is possible that none of the listed side effects will occur.

In general, the side effects listed here are not related to occasional steroid injections for arthritis, tendonitis, or bursitis.

Prolonged use

However, use that involves high doses and is prolonged (for a few months to several years) may result in an increase in side effects.

Chronic use of a high dose is justified only when severe illness poses serious risks to the patient.

Associated Risks

• Adults and older adults are more likely to develop problems with high blood pressure and diabetes.

• In addition to suppressing immunity, corticosteroids can also cause infection like measles and chickenpox to be more severe..

• It is also possible to affect other medications with corticosteroids. However, interactions with steroid sprays and injections are relatively uncommon.

• Prolonged treatment at high doses – especially with steroid tablets – can cause problems in some people as it may reduce the function of the adrenal glands.

• In addition to tobacco and alcohol, certain medications, such as corticosteroids, can interact with each other.

If you regularly smoke or drink, talk to your doctor to see what it may do to your treatment.

Prescription Guidelines

Corticosteroids are only prescribed if the potential benefits of treatment outweigh the risks.

Additionally, those medications will be prescribed at their lowest effective dose for the shortest possible time to reduce any adverse reactions.

Steroid injections, inhalers, or short courses of steroid tablets rarely result in severe side effects.

If you find side effects after taking corticosteroids, you must continue taking your medication until your doctor tells you it is safe to do so, due to the potential for unpleasant withdrawal effects.

If you have been taking corticosteroids for a long time, you may need to reduce your dose slowly over a few weeks or months, and you may have to undergo tests to ensure that your adrenal glands are still functioning

Corticosteroid tablets are the most powerful type of steroid medication, as they are beneficial.

If you have an ongoing, widespread infection, you shouldn't use them. It is possible to make your infections worse, however, this would be discussed with your doctor.

Types of Corticosteroids

A number of corticosteroids can be found locally or systemically.

These drugs are most commonly available in oral, topical, and injectable forms.

The most common are:

• Prednisone

• Mometasone

• Clobetasone

• Hydrocortisone

• Beclometasone

• Betamethasone

• Clobetasol

• Fluticasone

What's Male Infertility?

Male infertility is any condition that reduces the chances that a woman will become pregnant, and do not conceive usually after a year of trying has passed.

Many couples cannot achieve pregnancy.

Numerous causes of infertility affect men and women.

The symptoms of male infertility are often not noticeable.

However, if you are suffering from a condition such as low testosterone which can affect male fertility, there may be symptoms such as reduced muscle mass, fatigue, erectile dysfunction and fat gain amongst others.

If you recognize these symptoms whilst you're trying for a baby, it could be related.

The likelihood of being infertile can be increased if you are exposed to, or are suffering from the following:

• You're overweight or obese.

• You've been exposed to radiation.

• Environmental toxins have been exposed to you, including lead, calcium, pesticides, or mercury.

• It raises your testes' temperature when you are around heat. The experience may occur to those who frequently use saunas, hot tubs, wheelchairs or laptops.

• Historically, you have undescended testicle(s).

• Genetic diseases, such as Klineflatter's syndrome, myotonic dystrophies, microdeletion, etc.

• Poor nutritional habits. This could be the high consumption of high fat, high sugar, and processed foods with little intake of fresh fruits, vegetables, lean meats, fish, nuts, seeds and legumes.

• Conditions such as diabetes, autoimmune disorders, cystic fibrosis, and infections are examples of these conditions.

• Chemotherapy, radiation, or surgery that removes the testicles (one or both) are used to treat cancer.

• Males who suffer from low testosterone often require injections, implants, or a topical gel that can reduce your own hormone functions.

• High levels of alcohol consumption, smoking, illegal drug use, and anabolic steroids.

Do Corticosteroids Affect Male Infertility?

As male infertility is increasing, there is a growing concern that corticosteroids, given as injections or applied topically, could be contributing to this trend.

Typically, anabolic steroid use does seem to reduce male fertility, however, the same cannot be said for corticosteroids according to the evidence available.

Again, we must appreciate that anabolic steroids and corticosteroids bind to different receptors, and therefore have different effects on the body.

A published study of 2004 reported that their research of other papers showed that corticosteroid treatment increased the rate of conception by improving sperm count and sperm motility.

Research conducted by the University of Wales College of Medicine found that a high dose of corticosteroids was able to restore the function of the testicles and produce fertile sperm.

A study published by the Urology Times Journal of 2020 suggests that corticosteroid treatment helps improve the total number of motile sperm for those who undergo a vasectomy reversal procedure.

Research from the 1970s discovered that corticosteroids used to treat men with very low sperm count or zero sperm count resulted in improvements and pregnancy.

For those men who are infertile due to circulating antisperm antibodies corticosteroids may help.

A published study of 2009 noted that antisperm antibody levels were reduced whereas sperm density and other parameters significantly improved.

That said, even with these positive results, it did not appear to positively influence pregnancy rates among the participants.

Conclusion

We have learned that corticosteroids are useful to help alleviate numerous medical conditions, these can range from skin problems, joint inflammation, and other inflammatory conditions such as diabetes.

Overall, short term use of corticosteroids should not cause too many complications or side effects, if any. However, there is more concern over prolonged use.

That said, if the benefits outweigh the risks, medical professionals may still prescribe them.

It is also important to note that corticosteroids, whilst being called steroids, are different from anabolic steroids, and both have different effects on the body.

Effects on Male Fertility

Numerous research papers, studies and journal publications have found that corticosteroids have a positive effect on male fertility, particularly sperm health.

Furthermore, its positive effects appear to help a few different sperm related conditions which have previously prevented conception.